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COUNTY OF SAN JOAQUIN Date: � / li/b 7 <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> DRIVEWAY AND PAVED FRONTAGES CR# D <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE <br /> ame ` APN - 210 _ 3 o FEE DUE <br /> I1I/i• vyj � Z53 <br /> /� S� EXP.DATE DRIVEWAYS: <br /> Ad ess S STREET <br /> AREA QUAD 5kJ <br /> City,State-Zip Code /7 TYPE ZXA-> <br /> —7- rte,— �� Y S�3C�y� FORMS <br /> ( ea Code)Telephone NOTE ' <br /> SITE INFORMATION /Uo �/ SGuG�� recGmn-,e�d�d <br /> Parcel Owner's Name <br /> Site Address <br /> DRIVEWAY <br /> City,ySiate-Zip Code TYPE QUANTITY WIDE <br /> AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL 2 <br /> INDUSTRIAL @ RIW <br /> RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> Name LENGTH: Ft. X WIDTH: Ft. <br /> Address The undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the $py side of L+MhG 1201, <br /> City,State-Zip Code approximately d,G 0 feet mile Ajf e.¢- of <br /> by installing <br /> (Area Code)Telephone <br /> will commence on or about for approximately days., Work <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? NO _ YES Contractor's License <br /> Acc=\Per AppTormlDrivewayPaved frontage <br />